NEW BRUNSWICK WILDLIFE TRUST FUND / by lwIAX807

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									                                                                     B: APPLICATION FORM
                    2012
                   ______________________________________________________________________________
                    0987
       NEW BRUNSWICK WILDLIFE TRUST FUND
                  FUNDING APPLICATION FORM
                          (Refer to guidelines when completing)
Please also complete Financial Budget Template (EXCEL)
                                                                         PROJECT #
SECTION I - APPLICATION SUMMARY                                          DATE REC’D:
                                                                         Office use only
DATE:

PROJECT TITLE:
PROGRAM (Fisheries, Wildlife, Trapping, Biodiversity or Education):
LOCATION OF PROJECT: COUNTY:                                   PARISH:
NAME OF WATERCOURSE (if project involves a stream or brook):
        which is a tributary of
NAME OF APPLICANT (company/group/person):
    CONTACT PERSON OR PROJECT SUPERVISOR:
    RELATIONSHIP TO ORGANIZATION: _______________________________________________
    TEL: BUS:                        HOME:                          E-MAIL:
    SIGNATURE OF THESIS OR STUDY SUPERVISOR:
MAILING ADDRESS:
                                                               POSTAL CODE:
TEL:                              FAX:                       E-MAIL:
WEBSITE ADDRESS:
MAILING ADDRESS FOR PAYMENT IF DIFFERENT THAN ABOVE:


HST Registration No. (If applicable):


BUDGET SUMMARY OF PROJECT
                                                        $                 %
        Total Cost of Project (including in-kind)                        100
        Amount Requested from NBWTF



Revised September 2011                                                                         1
                                                                     B: APPLICATION FORM
                                        2012
                   ______________________________________________________________________________
D            S
 ESCRIPTIVE UMMARY OF       P ROJECT    0987
                                      : Describe in 100 words or less what you want to achieve
and how it would benefit wildlife in New Brunswick




SECTION II – APPLICANT INFORMATION Background of the organization
(mandate, years in existence, membership, accomplishments).



                         PROJECT HISTORY SUMMARY To be completed only if
proposal is building on, or is a continuation of a previous year's project which was supported by
a NBWTF funding.

    1. PREVIOUS YEAR (S) PROJECT TITLE(S) AND NUMBER(S); AND FUNDING AMOUNT(S)
       RECEIVED FROM NBWTF:
    2. SUMMARIZE ACTIVITIES PERFORMED DURING PREVIOUS YEAR(S) THE PROJECT WAS
       FUNDED:
    3. SUMMARIZE THE RESULTS OBTAINED DURING THE PREVIOUS YEAR(S) THE PROJECT WAS
       FUNDED:



SECTION IV – PROJECT INFORMATION
    1.  PROJECT TITLE:
    2.  REASONS / PURPOSE FOR THE PROJECT:
    3.  OBJECTIVES:
    4.  PROJECT DESCRIPTION:
           i. Location of project
                a) Circle or underline applicable options
                 on private and/or  Crown land
                b) Provide a Detailed Map for stream, fish and/or terrestrial habitat improvement
                projects.
           ii. Methods:
           iii. Equipment and materials required:
           iv. Personnel required:
    5. PROPOSED START-UP AND COMPLETION DATES:
    6. TYPE OF DATA RECORDED AND WHERE IT WILL BE HOUSED:
    7. MONITORING:
    8. SHORT-TERM ACHIEVEMENT
    9. LONG-TERM ACHIEVEMENT
    10. PREVIOUS STUDIES:
    11. REQUIRED PERMITS AND LANDOWNER AGREEMENTS:


Revised September 2011                                                                         2
                                                                     B: APPLICATION FORM
                                         2012
                   ______________________________________________________________________________
    12. CONSULTANTS :
    13. SHORT-TERM/LONG-TERM COMMITMENT
                                         0987
                                            :
    14. PROJECT DURATION:
    15. PROJECT EVALUATION:


SECTION V – COMMUNICATION STRATEGY

    1.     PROMOTION OF PROJECT:
    2.     PROMOTION OF NBWTF:
    3.     PUBLICATION OF RESULTS:


SECTION VI – SOCIO ECONOMIC IMPACT

    1.     COMMUNITY BENEFITS:
    2.     EFFECTS ON TRADITIONAL USES:
    3.     POSSIBLE CHANGES IN PUBLIC ACCESS TO PROJECT AREA(S):


SECTION VII – ENVIRONMENTAL IMPACT

    1.     IMPACT ON WILDLIFE AND/OR THE ENVIRONMENT:


SECTION VIII – FUNDING

    1. LIKELIHOOD   OF FUTURE REQUESTS FOR NBWTF FUNDING FOR THIS PROJECT IN
    SUBSEQUENT YEARS:
    2. LIST ALL OTHER FUNDING SOURCES FOR THIS PROJECT:

PLEASE ALSO DOWNLOAD AND COMPLETE FINANCIAL BUDGET
TEMPLATE (EXCEL)

(Please download the Financial Budget Template (EXCEL format) to complete the sections A,
B, C, and D)




Revised September 2011                                                                         3

								
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